Funnel plots, performance variation and the Myocardial Infarction National Audit Project 2003-2004.
Funnel plots, performance variation and the Myocardial Infarction National Audit Project 2003-2004.
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DOI：
10.1186/1471-2261-6-34
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发表时间：
2006-08-02
影响因子：
2.1
通讯作者：
Hall, Alistair S
中科院分区：
文献类型：
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作者：
Gale, Christopher P;Roberts, Anthony P;Hall, Alistair S
背景技术背景：临床治理要求医疗保健专业人员提高护理标准，并导致临床性能数据的比较。心肌梗死国家审计项目（英国心脏病学数据集）列出了其性能。然而，漏斗图是机构比较的首选显示方法。我们的目的是证明，漏斗图可能来自MINAP数据，并允许更有意义的解释data.METHODS：我们研究了达到国家服务框架标准的所有医院（n = 230）和所有患者（n = 99,133）在MINAP数据库2003年4月1日和2004年3月31日之间。我们生成了漏斗图（控制限为3 σ）的门到针和呼叫到针溶栓时间，以及心肌梗死后阿司匹林、β受体阻滞剂和他汀类药物的使用。只有87,427名患者符合二级预防药物使用分析标准，111例患者按上门到针和呼叫到针时间进行分析（163家医院达到了上门到针时间的标准，215家医院在其控制限度内或以上）。116家医院的呼叫针时间在“25%以内”和“25%以上”的标准之外，但28家医院低于控制下限。16家医院未能达到AMI后阿司匹林使用标准，24家仍低于控制下限。30家医院低于β受体阻滞剂使用的CL下限，49家医院超出标准。他汀类药物的使用是comparable.CONCLUSION：漏斗图可以应用到一个复杂的数据集，并允许来自多个医疗保健单位的数据进行视觉比较。差异很容易被发现，使各单位能够评估其做法，以便有效地提高质量。
BACKGROUND: Clinical governance requires health care professionals to improve standards of care and has resulted in comparison of clinical performance data. The Myocardial Infarction National Audit Project (a UK cardiology dataset) tabulates its performance. However funnel plots are the display method of choice for institutional comparison. We aimed to demonstrate that funnel plots may be derived from MINAP data and allow more meaningful interpretation of data.METHODS: We examined the attainment of National Service Framework standards for all hospitals (n = 230) and all patients (n = 99,133) in the MINAP database between 1st April 2003 and 31st March 2004. We generated funnel plots (with control limits at 3 sigma) of Door to Needle and Call to Needle thrombolysis times, and the use of aspirin, beta-blockers and statins post myocardial infarction.RESULTS: Only 87,427 patients fulfilled criteria for analysis of the use of secondary prevention drugs and 15,111 patients for analysis by Door to Needle and Call to Needle times (163 hospitals achieved the standards for Door to Needle times and 215 were within or above their control limits). One hundred and sixteen hospitals fell outside the 'within 25%' and 'more than 25%' standards for Call to Needle times, but 28 were below the lower control limits. Sixteen hospitals failed to reach the standards for aspirin usage post AMI and 24 remained below the lower control limits. Thirty hospitals were below the lower CL for beta-blocker usage and 49 outside the standard. Statin use was comparable.CONCLUSION: Funnel plots may be applied to a complex dataset and allow visual comparison of data derived from multiple health-care units. Variation is readily identified permitting units to appraise their practices so that effective quality improvement may take place.